Incomplete Abortion - Symptoms, Causes, Risks and Treatment

An incomplete abortion is a partial loss of pregnancy tissue (foetal tissue, placenta, and blood) within the first 20 weeks of conception. The condition indicates that the foetal residue also known as Retained products of conception (RPOC) is still inside your uterus, and therefore, you need medical assistance to get it out.

Complete Abortion vs Incomplete Abortion

Many people have an understanding that complete abortion and incomplete abortion is the same thing, which is not true. Both of them are the subtypes of spontaneous abortion along with inevitable, missed, and threatened abortion.

Complete abortion refers to when all the foetal contents leave the uterus after abortion. Whereas, incomplete abortion is when the uterus's foetal contents aren't fully emptied. There are still considerable remains left inside the body, which eventually cause toxicity. Incomplete pregnancy is always more harmful than complete abortion as it has severe aftereffects. 

Signs and symptoms may start appearing soon after the incomplete abortion. The intensity of the symptoms can be mild, moderate, or severe. A patient can experience the following symptoms: 

1. Heavy Vaginal Bleeding: Moderate to severe vaginal bleeding is a common symptom of incomplete abortion as well as abortion that should not be ignored. 
2. Pain and Discomfort: One can experience frequent lower abdomen or pelvic discomfort that spreads to the lower back, buttocks, genitalia, and perineum (skin patch between genitals and anus). 
3. Blood Clot Discharge: The patient may spot blood clot discharge, a common symptom of incomplete abortion. 
4. Fever and Chills: If the patient experiences persistent fever, chills and diarrhoea soon after the abortion, that may indicate incomplete abortion.
5. Nausea and Vomiting: Apart from all other symptoms, the patient may feel nauseating and experience frequent vomiting.

Almost 50% of cases of incomplete abortion occur due to genetic problems inside the foetus. Other cases of incomplete abortion occur due to other modifiable causes. Some of the causes of incomplete abortion include:

1. Incompetent Cervix: A condition in which weak cervical tissue causes premature birth or loss of a healthy pregnancy. A weak cervix is a condition where there's a structural issue with your cervix. If your cervix is weak, it can shrink and open up in the second or third trimester without any signs of labour. If this happens, you could end up having a late miscarriage which can lead to incomplete miscarriage or labour before your due date.
2. Structural Abnormalities: Structural abnormalities can hinder the complete expulsion of pregnancy tissue. Certain structural abnormalities of the uterus, such as uterine fibroids or congenital malformations, can increase the risk of incomplete abortion.
3. Hormonal Imbalance: Hormonal imbalances, such as low levels of progesterone, can lead to incomplete abortion. Progesterone is a hormone that helps maintain the uterine lining and support pregnancy. If progesterone levels are too low, the uterine lining may not be able to support the pregnancy, leading to incomplete abortion.
4. Unsafe Abortion / Illegal Abortion: Illegal medical abortions without proper medical professionals' supervision can lead to incomplete abortion.
5. Medical Termination of Pregnancy: According to a study done by the National Library of Medicine (NLB), the Medical method of abortion (MMA) is a safe, efficient, and affordable method of abortion. However, incomplete abortion is a known side effect. MTP (medication abortion) may result in incomplete abortion if the medications fail to fully expel all pregnancy tissue, especially in cases of advanced gestational age or if the medications are not taken correctly.

There are various risk factors that can increase the chances of incomplete abortion. Below mentioned are some of the factors that cannot be ignored. 

1. Poor Access to Healthcare: After a medical or surgical abortion, if the patient has limited or poor healthcare access, the patient is at a high risk of incomplete abortion.
2. Lack of Medical Care: During or after medical treatment, if proper medical care is not provided then there is a high chance of the patient getting infected. Proper medical care is necessary for all.
3. Advanced Maternal Age:  Older women (over the age of 30) tend to develop more diseases like hypertension and diabetes, due to which the risk of incomplete abortion increases. 
   1. At 40, the risk of incomplete abortion is 40%.
   2. After 45, the risk of incomplete abortion is around 80%.
4. Molar Pregnancy: Women, who are diagnosed with molar pregnancy (a complication of pregnancy characterised by abnormal growth of embryonic cells, the cells that usually develop into the placenta), typically aged between 15 to 20 years old, have a 13% chance of incomplete abortion.During molar pregnancy, the cells of the foetus show irregular growth. Also, the pregnancy hormones increase, which increases the chance of incomplete abortion.
5. Lifestyle Factors: Women who smoke during pregnancy are at higher risk of incomplete abortion than non-smokers. Consumption of alcohol and the use of drugs also increases the risk of incomplete abortion.
6. Harmful Radiations: Exposure to high levels of toxic agents and radiation in the workplace or environment can directly affect foetal growth and increase the risk of incomplete abortion.

One cannot prevent incomplete abortion, but proper care can reduce the risk of incomplete abortion. The following steps may help one lower the risk of incomplete abortion:

1. Screening at Regular Intervals: The patient should undergo an ultrasound at regular intervals after the abortion. Ultrasound helps the physician confirm the pregnancy length and aids in follow-up procedures.
2. Professional Assistance: Getting an abortion from a trained medical professional and from a registered hospital is essential to terminate the chances of incomplete abortion.
3. Early Diagnosis: Early diagnosis of systemic diseases (diseases that affect the entire human body), such as flu, high blood pressure, or other diseases, can help provide treatment at the right time.
4. Spotting Early Signs: If the patient is experiencing signs of incomplete abortion, like vaginal bleeding and abdominal cramps during the first 20 weeks of pregnancy, she must seek medical attention immediately.
5. Avoid Direct Exposure to X-Rays: A pregnant woman should avoid direct exposure to X-rays, as X-rays can increase the chances of incomplete abortion.

To diagnose incomplete abortion, the doctor orders a pelvic exam to see if the cervix is open (dilated) or thinned out (effacement). Other tests and exams that can help diagnose an incomplete abortion include: 

1. Doctor’s Consultation: The doctor diagnoses with the help of a stethoscope and pulse rate. If the doctor is unable to detect a heartbeat at a prenatal checkup, then they do a physical examination. Sometimes, it’s too early to check for a heartbeat. 
2. Physical Examination: If the patient experiences expulsion of unusual tissue or blood clots through the vagina,  she should get the sample tested in the lab to confirm if the tissue is foetal remains. She should also check whether her symptoms are related to any other health condition.
3. Blood Tests: Following blood tests can be performed to confirm incomplete abortion:
   1. Quantitative Human Chorionic Gonadotropin (hCG) Level: This blood test helps to determine the pregnancy hormone (hCG) levels in the blood. The hCG levels would be low in case of incomplete abortion. 
   2. Transvaginal or Transabdominal Ultrasound: The physician will conduct an abdominal or vaginal ultrasound to check if any foetal remains are left inside the foetus even after abortion.

How to prepare for a doctor’s consultation?

If the patient is experiencing any signs and symptoms of abortion, she must contact the doctor immediately. The following information will help prepare the patient for the appointment:-

What to Ask the Doctor?

The following questions on incomplete abortion could be asked a doctor:

1. What are the safest treatment options available for an incomplete abortion?
2. What are the tests required for diagnosis?
3. Are any restrictions required before treatment?
4. What can be the possible cause for incomplete abortion?
5. What are the worrisome signs and symptoms?
6. Can incomplete abortion affect future pregnancy?

 What to Expect from the Doctor? 

The doctor also asks specific questions from the patient, such as:

1. When was the patient’s last menstrual period? 
2. Was the patient using any sort of contraception at the time she conceived? 
3. When did the signs and symptoms first appear? 
4. Whether the patient has been experiencing continuous or occasional symptoms? 
5. Is the bleeding heavy, regular, or less than the patient typically experiences during her periods? 
6. Has the patient experienced any complications during her previous pregnancy? 
7. Has the patient had a miscarriage before? 
8. Does the patient have any other health conditions that can affect her pregnancy? 
9. What is the blood type of the patient? 

Ask the doctor if there are any restrictions to follow pre-appointment. 

Bring a loved one to the hospital during the doctor’s appointment. Due to stress and fear, the patient may find it challenging to focus on all the details and information provided by the doctor. 

Make a note of all the questions that need to be asked by the doctor. 

If a woman is experiencing any incomplete abortion symptoms, she should seek medical attention as soon as possible. Early incomplete abortion treatment can help avoid heavy blood loss and the risk of infection.

Before deciding on the treatment option, one must discuss the pros and cons of every treatment carefully with the doctor and express any concerns.

Seeking guidance and support from medical experts will help make an informed decision about the treatment choice. Incomplete abortion can be treated using any of the following three approaches:

Non-Surgical Treatment for Incomplete Abortion

Non-surgical treatments of incomplete abortion may or may not provide a permanent treatment to the patient. Following are the two main non-surgical treatment options to get rid of incomplete abortion: 

1. Expectant Management: Expectant management means waiting for the miscarriage to happen by itself naturally, without treatment. In most cases, the woman's body naturally removes the foetal contents from the uterus by shedding the uterine lining. The process is known as expectant management.
   1. It is a highly effective treatment method if incomplete abortion has occurred before or during the first trimester of pregnancy.
   2. In a few of the cases, the patients who choose expectant management may also need to undergo a Dilation and Curettage surgical procedure if the foetal contents are not fully expelled.
   3. There is a risk of heavy and persistent bleeding in this treatment method.
2. Medical Treatment: Misoprostol drug is widely used for incomplete abortion. The drug causes the uterus to contract and remove the foetal remnants.
   1. It is a faster treatment method than expectant management.
   2. Patients opting for medical treatment may also require a Dilation and Curettage procedure later if the foetal tissues are not entirely removed from the uterus.
   3. The success rate of misoprostol is 80 to 99% for pregnancies whose gestational age is 13 weeks or less.

Surgical Treatment for Incomplete Abortion

Surgical treatment options provide a permanent cure for incomplete abortion. Following are various surgical treatment options to treat incomplete abortion: 

1. Vacuum Aspiration: Vacuum aspiration, also known as suction aspiration or suction curettage, is a common method used to remove pregnancy tissue from the uterus during an abortion or following a miscarriage. Vacuum aspiration is generally a quick procedure that is performed on an outpatient basis. The actual duration may vary, but it typically takes around 5 to 10 minutes.
   1. The procedure involves dilating the cervix, inserting a slender tube called a cannula into the uterus, and connecting it to a suction device.
   2. The suction gently removes the pregnancy tissue and uterine lining. A small curette may also be used to ensure all tissue is removed.
2. Dilation and Curettage (D and C): The D and C procedure is used to treat incomplete abortion and is also used as a prevention method to stop heavy bleeding.
   1. To remove the foetal remnants from the uterus, the doctor generally scrapes the inner surface of the uterus with the help of a curette to gather and remove retained foetal tissues.
   2. This procedure for incomplete abortion does not involve dilating the cervix, as the cervix is usually open during the incomplete abortion.
   3. D and C are performed under general anaesthesia to avoid pain and discomfort during treatment.

Note: Heavy bleeding days after the D and C procedure, along with foul-smelling vaginal discharge, is a worrisome sign. If the patient has any of these, she must contact the doctor immediately.

Cost of Surgical Treatment for Incomplete Abortion

The cost of surgical treatment for incomplete abortion in India can vary depending on the intensity of the complication. Other factors that are associated with the cost include the type of surgery, the hospital or clinic where the procedure is performed, and the location.

Here is a table highlighting the cost of different types of Incomplete Abortion Surgery:

Although the complications of incomplete abortion are rare, it bears certain risks if not treated in time. Following are some of the risks and complications associated with incomplete abortion: 

1. Heavy Bleeding: Incomplete abortion may lead to heavy bleeding, which can cause anaemia, excessive blood loss, shock and death in rare cases. The blood discharge could be accompanied by blood clots or pieces of tissue.
2. Infection in the Uterus: Infection can occur if foetal remnants remain inside the uterus.
3. Cervical Dilation: Women with incomplete abortions have a high chance of cervical dilation, where the cervix widens in width.
4. Severe Cramps: Cramps experienced after incomplete abortion are quite severe and could be rhythmic or labour-like, although not as intense as full-term labour pain.
5. Scarred Uterus: Incomplete abortion can lead to uterine scarring, resulting in infertility and complications with conceiving a baby in future.

When to consult a doctor? 

If the patient has sought a medical or surgical abortion, she would need follow-up visits to confirm that the foetal remnants have been completely removed from the body. However, immediate medical attention is necessary if the patient experiences the following symptoms:

1. Heavy bleeding with or without abdominal cramps during pregnancy.
2. Passing of tissue or clot-like material through the vagina during pregnancy.
3. Emotional healing is as important as physical healing. It might take even longer for the patient to recover emotionally than physically. The patient should talk to her friends and family or seek a counsellor to discuss her feelings.

The patient might also want to consider the following things:

1. Ask the doctor if there are any restrictions to follow pre-appointment. 
2. Bring a loved one to the hospital during the doctor's appointment. Due to stress and fear, the patient may find it challenging to focus on all the details and information the doctor provides. 
3. Make a note of all the questions that need to be asked by the doctor.

A balanced diet is beneficial for maintaining good health and can help cope with incomplete abortion removal symptoms and complications. A patient can consider taking the following diet: 

1. Healthy diet
2. Iron-rich food
3. Fibre rich food
4. Avoid processed foods

Apart from maintaining a good diet, it is very important to stay hydrated. It will help the patient to cope with dehydration due to vomiting and will aid in improving mood. 

Incomplete abortion refers to a situation where not all of the foetal content got out from the uterus following a miscarriage or abortion procedure. It can occur due to unsuccessful medical abortion, uterine abnormalities etc. Prolonged bleeding, abdominal pain, and passage of clots etc are some of the incomplete abortion symptoms.

Management of incomplete abortion usually requires medical or surgical assistance to remove the remains of the conception product (foetus). Treatment options may include manual vacuum aspiration of the remaining tissues or a combination of medication and dilation and curettage (D&C) procedures. Timely medical attention is crucial to ensure the complete removal of pregnancy tissues and maintain the patient's health.

You can always contact the experts at HexaHealth to know more about incomplete abortion and the best surgical treatment options available for it. 

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